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Emerging Cancer Incidence, Mortality, Hospitalisation and Associated Burden Among Australian Cancer Patients, 1982

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Emerging Cancer Incidence, Mortality, Hospitalisation and Associated Burden Among Australian Cancer Patients, 1982 Open access Original research BMJ Open: first published as 10.1136/bmjopen-2019-031874 on 15 December 2019. Downloaded from Emerging cancer incidence, mortality, hospitalisation and associated burden among Australian cancer patients, 1982 – 2014: an incidence-based approach in terms of trends, determinants and inequality Rashidul Alam Mahumud ,1,2,3,4 Khorshed Alam,1,2 Jeff Dunn,1,5,6 Jeff Gow1,2,7 To cite: Mahumud RA, Alam K, ABSTRACT Strengths and limitations of this study Dunn J, et al. Emerging Objective Cancer is a leading killer worldwide, including cancer incidence, mortality, Australia. Cancer diagnosis leads to a substantial burden ► This study examined the trends, determinants and hospitalisation and associated on the individual, their family and society. The main aim burden among Australian cancer inequality in terms of incidence, mortality, hospital- of this study is to understand the trends, determinants patients, 1982 – 2014: an isation and associated burden of cancer (eg, years and inequalities associated with cancer incidence, incidence- based approach in life lost, years lost due to disability and disability- hospitalisation, mortality and its burden over the period terms of trends, determinants adjusted life years) in the Australian context over a 1982 to 2014 in Australia. and inequality. BMJ Open 33 year period. 2019;9:e031874. doi:10.1136/ Settings The study was conducted in Australia. ► This study was not captured in details inequalities bmjopen-2019-031874 Study design An incidence- based study design was used. regarding the cancer survivorship in terms of stage, Methods Data came from the publicly accessible ► Prepublication history and treatment procedures and utilisation of healthcare. Australian Institute of Health and Welfare database. additional material for this ► Although we have limited understanding of what is This contained 2 784 148 registered cancer cases over paper are available online. To driving these changes in cancer outcomes as report- view these files, please visit the study period for all types of cancer. Erreygers’ ed here they may reflect random variation or chang- the journal online (http:// dx. doi. concentration index was used to examine the magnitude es in unknown risk factors, and therefore highlight http://bmjopen.bmj.com/ org/ 10. 1136/ bmjopen- 2019- of socioeconomic inequality with regards to cancer the need for more research into the aetiology of 031874). outcomes. Furthermore, a generalised linear model was cancer. constructed to identify the influential factors on the overall Received 28 May 2019 burden of cancer. Revised 25 October 2019 Accepted 01 November 2019 Results The results showed that cancer incidence (annual average percentage change, AAPC=1.33%), hospitalisation BACKGROUND (AAPC=1.27%), cancer- related mortality (AAPC=0.76%) Non- communicable diseases (NCDs) are and burden of cancer (AAPC=0.84%) all increased accountable for the majority of global deaths.1 significantly over the period. The same- day (AAPC=1.35%) Cancer is expected to rank as the most signif- on September 27, 2021 by guest. Protected copyright. and overnight (AAPC=1.19%) hospitalisation rates also icant global public health problem and a showed an increasing trend. Further, the ratio (least- most leading cause of death and illness in the world advantaged economic resources ratio, LMR of mortality in the 21st century2–6 including Australia.7 In (M) and LMR of incidence (I)) was especially high for 2019, it is estimated that almost 145 000 new cervix (M/I=1.802), prostate (M/I=1.514), melanoma (M/ I=1.325), non- Hodgkin's lymphoma (M/I=1.325) and cases of cancer will be diagnosed in Australia, breast (M/I=1.318), suggesting that survival inequality was and 35% of these individuals will eventually 7 most pronounced for these cancers. Socioeconomically die from the disease. Cancer accounts for © Author(s) (or their disadvantaged people were more likely to bear an the highest burden of disease of any illness, at employer(s)) 2019. Re- use increasing cancer burden in terms of incidence, mortality approximately 18% (19% for males; 17% for permitted under CC BY- NC. No commercial re- use. See rights and death. females), followed by cardiovascular disease and permissions. Published by Conclusions Significant differences in the burden of (14%), musculoskeletal (13%) and mental BMJ. cancer persist across socioeconomic strata in Australia. health (12%).8 Approximately 40% of cancer For numbered affiliations see Policymakers should therefore introduce appropriate patients are of working age in Australia.7 end of article. cancer policies to provide universal cancer care, which Among those in employment, 46% are unable could reduce this burden by ensuring curable and to return to work after an episode,9 and 67% Correspondence to preventive cancer care services are made available to all return to employment or change their job Mr Rashidul Alam Mahumud; people. Rashed. Mahumud@ usq. edu. au after being diagnosed.10 The majority of Mahumud RA, et al. BMJ Open 2019;9:e031874. doi:10.1136/bmjopen-2019-031874 1 Open access BMJ Open: first published as 10.1136/bmjopen-2019-031874 on 15 December 2019. Downloaded from cancer survival patients depend on family, relatives and cancer incidence has increased,5 17 23–25 which has been friends for physical and economical support during their more pronounced among adolescents and young adults,26 treatment and/or in the last stages of the disease.9–12 and older adults,27 yet cancer- related mortality rates have Cancer- related illness results in a substantial number of slightly dropped.28 Some types of cancer in Australia are patients experiencing economical hardship due to high the highest in the world: melanoma,26 keratinocyte and out- of- pocket expenses (eg, medicines and treatments, melanocyte.29 Australia and New Zealand together have including diagnostics), lost productivity, loss/reduc- the highest rates for Merkel cell carcinoma.30 31 A number tion of household income and other induced expendi- of studies have focused on geographical or socioeconomic ture.9 10 12 13 The economic burden of cancer is of growing disparities in cancer care and survival.32–38 These have concern for policymakers, healthcare practitioners, physi- usually been conducted in small settings at the Austra- cians, employers and society overall.10 12 Furthermore, the lian state level. No previous studies have attempted to magnitude of the cancer burden increases significantly measure the trends, associated determinants and magni- with remoteness from treatment sources and those indi- tude of socioeconomic inequalities of cancer outcomes viduals in depressed socioeconomic circumstances.14–16 (eg, incidence, mortality, hospitalisation and burden of Considerable progress has been made in recent decades cancer - YLL, YLD, DALYs) over time. Therefore, national in terms of cancer survival and reduced mortality rates17 18 level trends, the differential socioeconomic inequality of through several initiatives including introducing primary cancer outcomes, as well as influential factors associated preventive strategies and effective collaboration with with the cancer burden in Australia are unclear. non- government organisations and other stakeholders. Furthermore, the study’s findings will provide authori- Therefore, a reduction of cancer incidence, along with ties with national evidence about the trends and magni- improvements in cancer treatments and therefore survival tude of the inequalities in cancer burden and hopefully rates, are essential to reduce the burden of the disease. assist in developing low- cost interventions to reduce this Economic disparities between socioeconomically advan- burden. This study thus aims to examine the trends, asso- taged and disadvantaged individuals and groups are wors- ciated determinants and magnitude of socioeconomic ened by the increasing burden of cancer in Australia.15 inequality as related to incidence, mortality, YLL, YLD The lack of appropriate services are significantly worse and DALYs, as a result of cancer. in resource- poor settings, including geographically disad- vantaged areas compared with more advantaged people and communities with easier access to a greater range METHODS of cancer services, increased knowledge and awareness Study design of cancer prevention and better and more easily acces- An incidence- based approach was used to examine the 15 19 20 sible health facilities and resources. Other common trends and socioeconomic inequalities associated with reasons for such disparities include limited affordability adverse cancer outcomes in Australia. A health system http://bmjopen.bmj.com/ and accessibility of cancer care services for individuals perspective was adopted and cancer- related data were 16 from socioeconomically disadvantaged groups, and their accessed from organisations that are committed to 21 inadequate utilisation of healthcare. Thus, increased promote, restore or maintain health and well-being. 39 40 cancer incidence leads to a higher overall burden for the The study population represented different population individual, family and society, which is exacerbated for subgroups using characteristics such as sex, geographical the more disadvantaged. distribution and economic circumstances. In the recent past, disparities related to cancer outcomes have become the subject of international focus Australian health system on September 27, 2021 by guest. Protected copyright. and new service initiatives.2 6 In 2016, the WHO Executive
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